Ruth Elizabeth Watkinson, PhD
Transgender, non-binary, and gender-diverse individuals are at risk of having a long-term mental health condition, according to a new study from England.1
“We found evidence of wide gender-related inequalities in the prevalence of reported long-term mental health conditions, with inequalities concentrated in patients younger than 35 years,” wrote investigators, led by Ruth Elizabeth Watkinson, PhD, from the University of Manchester.
The study found approximately 1 in 6 transgender men (16.4%) and women (15.9%) in England are at risk of having a long-term mental health condition, which is greater than the ratio of 1 in 10 for cisgender men (8.8%) and women (12%). Additionally, 1 in 2 of non-binary transgender individuals are at risk of mental health conditions (47.2%).
Prior research suggested a greater risk of mental health conditions, including depression and anxiety, among transgender, non-binary, and gender-diverse patients compared to cisgender men and women. A Trevor Project survey found nearly 1 in 5 transgender individuals attempted suicide in 2021, which is greater than the American Foundation for Suicide Prevention which found 1 in 200 adults attempt suicide.2 Since previous studies were small, focusing on specific groups including students or patients seeking gender-affirming healthcare, Watkinson and colleagues wanted to explore the mental health condition risk for a full population.1
“Trans, non-binary and gender diverse people across England face widespread discrimination, leading to stressful social interactions and feelings of unacceptance, increasing the risk of poor mental health,” said investigator Luke Munford, PhD, from the University of Manchester, in a press release. “Additionally, gender dysphoria—a sense of unease due to a mismatch between a person’s biological sex and their gender identity—may increase the risk of poor mental health amongst some trans, non-binary, and gender diverse people, especially when combined with very long waiting times for NHS gender identity clinics.”
The study included data from both the 2021 and 2022 English GP Patient Survey. In the survey, respondents, > 16 years old, selected the following responses for their gender: female, male, non-binary, prefer to self-describe, and prefer not to say. The survey asked how their gender identity changed from their sex registered at birth with the options of cis, trans, and prefer not to say. Furthermore, the survey asked whether participants had a mental health condition and if healthcare professionals acknowledged any of their mental health needs during their last general practice appointment.
The survey did not ask about specific mental health conditions, but previous research found common mental health conditions for transgender, non-binary, and gender-diverse populations include anxiety, depression, eating disorders, self-harm, and suicidality.
Overall, 1,520,547 responded to the survey, and of the respondents, 98.3% were cisgender with 41.4% females and 47.4% males, 1% preferred not to say, 0.7% were transgender, 0.3% were non-binary, and 0.2% were people who chose to self-describe their gender. Gender diversity was greatest among younger age groups < 35 years (3.01%) and lowest among older age groups ≥ 65 years (0.96%).
After controlling for age in an age-adjusted logistic regression, the investigators found transgender patients (female:15 – 87%; 95% confidence interval [CI], 13.76 –18.24]), male (16 – 40% [95% CI, 14.14 –18 – 94]) and cisgender non-binary patients had a greater risk of reporting a long-term mental health condition than cisgender men and women (15- 78%; 95% CI, 12.82 – 19·27.
Moreover, 1 in 6 cisgender men and women reported their mental health needs were unmet (15.6% and 15.9%, respectively). Individuals with other gender identities had greater unmet mental health needs. Unmet mental health needs for other gender identities ranged from 1 in 5 (20%) and 1 in 4 (28.6%).
Limitations the investigators highlighted included leveraging data from 2 surveys so some participants could have been resampled, participants self-reporting and answering questions with clinical language which could have affected them reporting if they have a mental health condition or not, and the small proportion of participants responded “prefer not to say” to gender-related questions. Although participants who responded “prefer not to say” had a high prevalence of unmet mental health needs, the team wrote how it was good they included this option.
“Poor communication from health-care professionals and inadequate staff-patient relationships may explain why trans, non-binary, and gender diverse patients were more likely to report their mental health needs were not met at recent general practice appointments,” Watkinson said in the press release. “Changes are urgently needed for the NHS to become a more supportive service to transgender, non-binary, and gender diverse patients, including improved recording of gender across health-care records systems and staff training to ensure health-care professionals meet the mental health needs of all patients, whatever their gender.”
